Overview of microbes in hypertension

High blood pressure (BP), known as hypertension, is a major contributing factor to the development of cardiovascular disease. The development and pathogenesis of hypertension involve a wide array of factors including genetics, environment, hormones, hemodynamics, and inflammation. There is a significantly positive association between higher levels of colonization by Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola (etiologic bacterial burden) below the gum line, and the presence of hypertension. The use of antibiotics during pregnancy, which is likely indicative of bacterial infections severe enough to require antibiotic treatment, is associated with a slight increase in average arterial BP. Cytomegalovirus infection is a risk factor for heightened arterial BP and acts as a co-factor in the development of aortic atherosclerosis. The relationship between hypertension and coronavirus disease 2019 involves endothelial dysfunction and dysregulation of the renin-angiotensin system. The effects of gut microbiota on BP, whether beneficial or harmful, are influenced by multiple factors including genetics, epigenetics, lifestyle choices, and antibiotic usage. These variables collectively contribute to overall BP levels and the control of hypertension. Several reports have examined the BP levels of patients infected with the Zika virus. In regions with a high incidence of nasopharyngeal carcinoma, hypertension has been linked to a higher risk of Epstein-Barr virus reactivation. Also, a potential causal link has been found between malaria and elevated BP. Also, the elevated prevalence of hypertension among dengue patients during their initial visit suggests that relying solely on BP measurements to predict severe infection may not be clinically reliable.

Role of major adipokines in hypertension: A literature review

The incidence and prevalence of hypertension are increasing as a consequence of the obesity epidemic. Adipocytes and their variety of factors make contributions to the long-term regulation of blood pressure. The pathophysiologic states of hypertension, including obesity, are regulated by the production of adipocyte-derived factors. Increased body mass index was closely linked to elevated blood pressure. Mostly the hypertensive subjects were obese as well as overweight. There are numerous adipokines, however, this review article only focuses on the major adipokines including chemerin, visfatin, retinol-binding protein 4, plasminogen activator inhibitor-1, monocyte chemotactic protein-1, omentin-1, lipocalin-2, vaspin, progranulin, complement c1q tumor necrosis factor-related protein, and nesfatin-1 role in the pathogenesis of hypertension. This review article concludes the significant association of major adipokines in the pathogenesis of hypertensives. New research should be focused on other newly reported adipokine roles in hypertensive subjects and the management of these adipokines in hypertensive subjects. The discovery of this information could result in the creation of antihypertensive medications, particularly those that focus on obesity-related hypertension.

Cardiac markers: Role in the pathogenesis of arterial hypertension

Cardiac biomarkers may play unique roles in the prognostic evaluation of patients with hypertension, as many cardiac biomarker levels become abnormal long before the onset of obvious cardiovascular disease (CVD). There are numerous cardiac markers. However, this review article only reported the roles of creatinine kinase-MB, cardiac troponins, lipoprotein a, osteopontin, cardiac extracellular matrix, C-reactive protein, cardiac matrix metalloproteinases, cardiac natriuretic peptides, myoglobin, renin, and dynorphin in the pathogenesis of hypertension. This article explained recent major advances, as well as discoveries, significant gaps, and current debates and outlined possible directions for future research. Further studies are required to determine the association between myoglobin and other cardiac markers in hypertension. Moreover, therapeutic approaches are required to determine the early control of these cardiac markers, which ultimately reduce the prevalence of CVDs.

Self-efficacy for managing hypertension and comorbid conditions

BACKGROUND

Self-efficacy is defined an individual’s belief in completing necessary actions to achieve the desired goal. For individuals with hypertension and other chronic conditions, self-efficacy has been an essential factor to predict adherence to treatment behaviors.

AIM

To examine self-efficacy for managing chronic conditions in individuals with hypertension.

METHODS

A total of 1087 individuals with chronic conditions in two groups (hypertension and non-hypertension groups) were selected in this study. The two groups’ self-efficacy for managing chronic conditions were investigated using the five domains of patient reported outcomes measurement information system self-efficacy for managing chronic conditions measures (PROMIS-SE); daily activities, emotions, medication and treatment, social interactions, and symptoms. Also, the relationships between self-efficacy and other health-related outcomes for the hypertension group were examined using structural equation modeling.

RESULTS

Among 1087 participants, 437 reported having hypertension. The hypertension and non-hypertension groups were statistically different in self-efficacy for managing daily activities [F (1, 598) = 5.63, P < 0.05]. Structural equation modeling indicated that for individuals with hypertension, two domains of PROMIS-SE (managing daily activities and emotions) significantly predict global physical health (P < 0.001 and P < 0.01 sequentially), and one domain (managing emotions) significantly predicts mental health (P < 0.001). Hypertension patients’ general quality of life was significantly predicted by global physical health (P < 0.001) and mental health (P < 0.001).

CONCLUSION

The hypertension group reported deficits in self-efficacy in managing daily activities as compared to the non-hypertension group. In this hypertension group, self-efficacy functioned as an indirect predictor of general quality of life, mediated by global physical and mental health.

Loss of cavin1 and expression of p-caveolin-1 in pulmonary hypertension: Possible role in neointima formation

BACKGROUND

Pulmonary hypertension (PH) is a progressive disease with a high morbidity and mortality rate; and neointima formation leads to the irreversibility of the disease. We have previously reported that in rats, monocrotaline (MCT) injection leads to progressive disruption of endothelial cells (EC), and endothelial caveolin-1 (cav-1) loss, accompanied by the activation of pro-proliferative pathways leading to PH. Four weeks post-MCT, extensive endothelial cav-1 loss is associated with increased cav-1 expression in smooth muscle cells (SMC). Exposing the MCT-treated rats to hypoxia hastens the disease process; and at 4 wk, neointimal lesions and occlusion of the small arteries are observed.

AIM

To identify the alterations that occur during the progression of PH that lead to neointima formation.

METHODS

Male Sprague-Dawley rats (150-175 g) were divided in 4 groups (n = 6-8 per group): controls (C); MCT (M, a single sc injection 40 mg/kg); Hypoxia (H, hypobaric hypoxia); MCT + hypoxia (M+H, MCT-injected rats subjected to hypobaric hypoxia starting on day1). Four weeks later, right ventricular systolic pressure (RVSP), right ventricular hypertrophy (RVH), lung histology, and cav-1 localization using immunofluorescence technique were analyzed. In addition, the expression of cav-1, tyrosine 14 phosphorylated cav-1 (p-cav-1), caveolin-2 (cav-2), cavin-1, vascular endothelial cadherin (VE-Cad) and p-ERK1/2 in the lungs were examined, and the results were compared with the controls.

RESULTS

Significant PH and right ventricular hypertrophy were present in M and H groups [RVSP, mmHg, M 54±5*, H 45±2*, vs C 20±1, P < 0.05; RVH, RV/LV ratio M 0.57±0.02*, H 0.50±0.03*, vs C 0.23±0.007, P < 0.05]; with a further increase in M+H group [RVSP 69±9 mmHg, RV/LV 0.59±0.01 P < 0.05 vs M and H]. All experimental groups revealed medial hypertrophy; but only M+H group exhibited small occluded arteries and neointimal lesions. Immunofluorescence studies revealed endothelial cav-1 loss and increased cav-1 expression in SMC in M group; however, the total cav-1 level in the lungs remained low. In the M+H group, significant endothelial cav-1 loss was associated with increasing expression of cav-1 in SMC; resulting in near normalization of cav-1 levels in the lungs [cav-1, expressed as % control, C 100±0, M 22±4*, H 96±7, M+H 77±6, * = P < 0.05 vs C]. The expression of p-cav-1 was observed in M and M+H groups [M 314±4%, M+H 255±22% P < 0.05 vs C]. Significant loss of cav-2 [% control, C 100±0, M 15±1.4*, H 97±7, M+H 15±2*; M and M+H vs C, * = P < 0.05], cavin-1 [% control, C 100±0, M 20±3*, H 117±7, M+H 20±4*; M and M+H vs C, P < 0.05] and VE-Cad [% control, C 100±0, M 17±4*, H 96±9, M+H 8±3*; M and M+H vs C, P < 0.05] was present in M and M+H groups, confirming extensive disruption of EC. Hypoxia alone did not alter the expression of cav-1 or cav-1 related proteins. Expression of p-ERK1/2 was increased in all 3 PH groups [%control, C 100±0, M 284±23*, H 254±25*, M+H 270±17*; * = P < 0.05 vs C].

CONCLUSION

Both cavin-1 loss and p-cav-1 expression are known to facilitate cell migration; thus, these alterations may in part play a role in neointima formation in PH.

Achieving control of resistant hypertension: Not just the number of blood pressure medications

Resistant hypertension (RH) has a prevalence of around 12% and is associated with an increased risk of cardiovascular disease, progression to end-stage renal disease, and even mortality. In 2017, the American College of Cardiology and American Heart Association released updated guidelines that detail steps to ensure proper diagnosis of RH, including the exclusion of pseudoresistance. Lifestyle modifications, such as low salt diet and physical exercise, remain at the forefront of optimizing blood pressure control. Secondary causes of RH also need to be investigated, including screening for obstructive sleep apnea. Notably, the guidelines demonstrate a major change in medication management recommendations to include mineralocorticoid receptor antagonists. In addition to advances in medication optimization, there are several device-based therapies that have been showing efficacy in the treatment of RH. Renal denervation therapy has struggled to show efficacy for blood pressure control, but with a re-designed catheter device, it is once again being tested in clinical trials. Carotid baroreceptor activation therapy (BAT) via an implantable pulse generator has been shown to be effective in lowering blood pressure both acutely and in long-term follow up data, but there is some concern about the safety profile. Both a second-generation pulse generator and an endovascular implant are being tested in new clinical trials with hopes for improved safety profiles while maintaining therapeutic efficacy. Both renal denervation and carotid BAT need continued study before widespread clinical implementation. Central arteriovenous anastomosis has emerged as another possible therapy and is being actively explored. The ongoing pursuit of blood pressure control is a vital part of minimizing adverse patient outcomes. The future landscape appears hopeful for helping patients achieve blood pressure goals not only through the optimization of antihypertensive medications but also through device-based therapies in select individuals.

Blood pressure goals: A moving target

Clinical guidelines on hypertension have evolved over the past several decades. Each recommends varying blood pressure (BP) cut-offs which define hypertension, determine the thresholds to initiate pharmacotherapy, and guide treatment targets. In addition, different techniques of measuring BP in clinical trials may further contribute to the discrepancies in the achieved BP targets. Physicians find it difficult to navigate through different recommendations for hypertension management based on studies among different age groups and patients with a variety of co-morbidities and target organ involvement. In 2003, JNC 7 recommended a BP goal of < 140/90 mmHg in the general population and < 130/80 mmHg in those with diabetes mellitus or renal disease. JNC 8 re-set the BP target at < 140/90 mmHg for all adults under the age of 60 regardless of co-morbidities, and an even higher target of < 150/90 mmHg for those 60 years or older without diabetes or chronic kidney disease. The more recent results of the Systolic BP Intervention Trial (SPRINT) have a significant influence on the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) guideline which redefines hypertension as BP ≥ 130/80 mmHg. It emphasizes individualized cardiovascular risk assessment and recommends a more aggressive BP target of < 130/80 mmHg and a treatment threshold based on the age, co-morbidities, and cardiovascular risk. The 2017 ACC/AHA guideline also advocates proper BP measurement and provides the estimates of corresponding BP values for clinic, home, and ambulatory BP monitoring measurements. A higher prevalence of hypertension is expected based on the ACC/AHA 2017 guideline. Its implementation may potentially lead to better BP control through enhanced awareness, improved adherence, and more timely initiation and intensification of pharmacologic therapy. Although there is no one-size-fits-all BP target, the ACC/AHA 2017 guideline is simple, inclusive and practical. Nonetheless, more studies are warranted to help further individualize BP goals for elderly patients and those with certain co-morbidities or multiple cardiovascular risk factors.

Association between G-protein β3 subunit gene and isolated systolic blood pressure elevation of greater than 130 mmHg: A large-scale cross-sectional study in the Japanese population

AIM

To investigate whether GNB3 C825T single nucleotide polymorphism (SNP) contributes to systolic blood pressure (SBP) ≥ 130 mmHg in a large-scale cross-sectional study among the Japanese population with diastolic blood pressure (DBP) < 85 mmHg.

METHODS

We analyzed 11008 Japanese subjects, including 2797 cases (SBP ≥ 130 and DBP < 85 mmHg) who were not taking anti-hypertensive medication and 8211 controls (SBP < 130 and DBP < 85 mmHg), all of whom enrolled in the genome banking project of the 21^st Century COE (Center of Excellence) Program at Jichi Medical University. Subjects were divided into four groups according to gender (male and female) and age (≤ 49 years and ≥ 50 years). GNB3 gene polymorphism was determined using the TaqMan probe method. We compared the frequencies of alleles and genotypes between cases and controls by chi-squared test. The strength of the associations was estimated by odds ratios (ORs) and 95%CI by using logistic regression analysis. The ORs were adjusted for age and body mass index.

RESULTS

Allele and genotype distributions significantly differed between cases and controls only in males aged ≤ 49 years. Compared to the CC genotype, a significant OR was obtained in the TT genotype among males aged ≤ 49 years.

CONCLUSION

This study indicates that the TT genotype of the GNB3 C825T SNP may contribute to SBP elevation of greater than 130 mmHg compared to the CC genotype in Japanese males aged ≤ 49 years.

Hypertension, type IV cardiorenal syndrome and chronic kidney disease: Pathophysiological and therapeutical approach

Hypertension represent one of the most important comorbid factors in chronic kidney disease (CKD) patients and its prevalence increases from 65% to 95% according to glomerular filtration rate decline. CKD patients need to maintain their blood pressure levels into 130/80 mmHg according to most recent guidelines. Despite of many therapeutic agents, achievement of ideal blood pressure levels remains so far from the ideal ones. Hypertensive disease represent most important risk factor to develop a type IV cardiorenal syndrome, while prevalence of end stage renal disease is still raising and it represents worldwide epidemiological challenge. Correct management of hypertensive disease can obtain better control on CKD progression.

Hypertension in low and middle-income countries: Challenges, gaps and limited resources specific strategies

In this article we aim to discuss the burden of hypertension in middle-income countries, the challenges and opportunities, identify some implementation gaps in some of the published initiatives and propose a few pillars that could benefit an upstream population health and health promotion. One billion people suffer from hypertension worldwide; however, the prevalence of hypertension in low and middle-income countries is higher than that in the industrialized countries. Hypertension affects 45% of African adults aged 25 and above, compared to the 36% North American prevalence rate; moreover, the death rate from hypertension in LMICs is higher the than that of the European countries (141 vs 93 per 10000, respectively). The association between increased systolic blood pressure and income reversed between the early 80s and the first decade of the 20^th century; the higher the per capita income the lower the risk of hypertension. Hence, unless an effective interventions, such as improving diagnosis and treatment, lowering salt intake, enhancing access and availability of fresh fruit and vegetable, and increasing leisure time physical activities are implemented, then low income countries epidemic is inevitable. In this article we aim to discuss the global burden of hypertension in low and middle-income countries, the gaps and challenges, identify the high-risk groups and propose a prevention and cost effective treatment strategic framework.

Reduction of diastolic blood pressure: Should hypertension guidelines include a lower threshold target?

Reduction of diastolic blood pressure to less than 60-80 mmHg does not improve mortality and may lead to adverse cardiovascular events in high risk patient populations. Despite a growing body of evidence supporting the J-curve phenomenon, no major society guidelines on hypertension include a lower threshold target for diastolic blood pressure. Many major society guidelines for hypertension have been updated in the last 5 years. Some guidelines include goals specific to age and co-morbid conditions. The Sixth Joint Task Force of the European Society of Cardiology and the Canadian Hypertension Education Program are the only guidelines to date that have recommended a lower threshold target, with the Canadian guidelines recommending a caution against diastolic blood pressure less than or equal to 60 mmHg in patients with coronary artery disease. While systolic blood pressure has been proven to be the overriding risk factor in hypertensive patients over the age of 50 years, diastolic blood pressure is an important predictor of mortality in younger adults. Post hoc data analysis of previous clinical trials regarding safe lower diastolic blood pressure threshold remains inconsistent. Randomized clinical trials designed to determine the appropriate diastolic blood pressure targets among different age groups and populations with different comorbidities are warranted. Hypertension guideline goals should be based on an individual’s age, level of risk, and certain co-morbid conditions, especially coronary artery disease, stroke, chronic kidney disease, and diabetes.

Role of adipocytes in hypertension

Although it has known for some time that obesity is associated with salt sensitivity and hypertension, recent data suggests that the adipocyte may actually be the proximate cause of this physiological changes. In the following review, the data demonstrating this association as well as the potentially operative pathophysiological mechanisms are reviewed and discussed.

RhoA signaling and blood pressure: The consequence of failing to “Tone it Down”

Uncontrolled high blood pressure is a major risk factor for heart attack, stroke, and kidney failure and contributes to an estimated 25% of deaths worldwide. Despite numerous treatment options, estimates project that reasonable blood pressure (BP) control is achieved in only about half of hypertensive patients. Improvements in the detection and management of hypertension will undoubtedly be accomplished through a better understanding of the complex etiology of this disease and a more comprehensive inventory of the genes and genetic variants that influence BP regulation. Recent studies (primarily in pre-clinical models) indicate that the small GTPase RhoA and its downstream target, Rho kinase, play an important role in regulating BP homeostasis. Herein, we summarize the underlying mechanisms and highlight signaling pathways and regulators that impart tight spatial-temporal control of RhoA activity. We also discuss known allelic variations in the RhoA pathway and consider how these polymorphisms may affect genetic risk for hypertension and its clinical manifestations. Finally, we summarize the current (albeit limited) clinical data on the efficacy of targeting the RhoA pathway in hypertensive patients.

Management of hypertension: Current state of the art and challenges

Hypertension is a major modifiable cardiovascular risk factor. Hypertension is also recognized as the most important risk factor for global disease burden. It is well established that a sustained reduction in blood pressure by drugs reduces the incidence of cardiovascular morbidity and mortality. In recent years, studies and new guidelines published for the management of hypertension. Awareness, treatment and control of hypertension are very poor, despite the new guidelines. We highlighted the management of hypertension in the light of current literature.

Roles of catecholamine related polymorphisms in hypertension

The objective of this review is to summarize current data obtained so far in catecholamine-essential hypertension (EH) relationships on a genetic basis. As the major elements driving the sympathetic system’s actions, catecholamines modulate a variety of physiological processes and mutations related to the system. This could generate serious disorders, such as severe mental illnesses, stress-induced disorders, or impaired control of blood pressure or motor pathways. EH is idiopathic, and the genetic basis of its causes and substantial interindividual discrepancies in response to different types of treatments are the focus of interest. Susceptibility to disease or efficacy of treatments are thought to reflect genomic variabilities among individuals. Therefore, outlining the available knowledge in functional genetic polymorphisms linked to EH will make the picture clearer and will help to establish future prospects in the field.

Renal venous hypertension

Renal venous hypertension usually seen in young, otherwise healthy individuals and can lead to significant overall morbidity. Aside from clinical findings and physical examination, diagnosis can be made with ultrasound, computed tomography, or magnetic resonance conventional venography. Symptoms and haemodynamic significance of the compression determine the ideal treatment method. This review of the literature discusses normal and pathological developmental aspects of renocaval venous segment and related circulatory disorders, summarizes congenital and acquired changes in left renal vein and their impact on development of renal venous hypertension. Also will be discussed surgical tactics of portosystemic shunting and their potential effects on renal hemodynamics.

Place of baroreceptor activation therapy in the treatment of resistant hypertension

This mini review describes the development of the therapeutic concept of baroreceptor stimulation over the last fifty years alongside the more recent introduction of it for the treatment of drug - resistant hypertension. The pros and cons of this strategy of treatment over renal sympathetic denervation are also discussed in the light of the results of the studies done in the last decade.

Regression of cardiovascular remodeling in hypertension: Novel relevant mechanisms

Asymptomatic organ damage due to progressive kidney damage, cardiac hypertrophy and remodeling put hypertensive patients at high risk for developing heart and renal failure, myocardial infarction and stroke. Current antihypertensive treatment normalizes high blood pressure, partially reverses organ damage, and reduces the incidence of heart and renal failure. Activation of the renin-angiotensin system (RAS) is a primary mechanism of progressive organ damage and, specifically, a major cause of both renal and cardiovascular fibrosis. Currently, inhibition of the RAS system [mainly with angiotensin I converting enzyme inhibitors or angiotensin II (Ang II) receptor antagonists] is the most effective antihypertensive strategy for normalizing blood pressure and preventing target organ damage. However, residual organ damage and consequently high risk for cardiovascular events and renal failure still persist. Accordingly, in hypertension, it is relevant to develop new therapeutic perspectives, beyond reducing blood pressure to further prevent/reduce target organ damage by acting on pathways that trigger and maintain cardiovascular and renal remodeling. We review here relevant novel mechanisms of target organ damage in hypertension, their role and evidence in prevention/regression of cardiovascular remodeling and their possible clinical impact as well. Specifically, we focus on the signaling pathway RhoA/Rho kinase, on the impact of the vasodilatory peptides from the RAS and some insights on the role of estrogens and myocardial chymase in cardiovascular hypertensive remodeling.

Dashing away hypertension: Evaluating the efficacy of the dietary approaches to stop hypertension diet in controlling high blood pressure

The dietary approaches to stop hypertension (DASH) diet has been developed and popularized as a non-pharmaceutical intervention for high blood pressure reduction since 1995. However, to date, a comprehensive description of the biochemical rationale behind the diet’s principal guidelines has yet to be compiled. With rising interest for healthy and reliable life-style modifications to combat cardiovascular disease, this review aims to compile the most recent and relevant studies on this topic and make an informed assessment as to the efficacy of and underlying mechanisms operant in the DASH diet. Specifically, the merits of lowering dietary intake of sodium and saturated fat, as well as increasing the intake of fruits, vegetables, fiber, and dairy, have been shown to attenuate hypertension individually. Upon review of this evidence, we conclude that the combination of dietary patterns proposed in the DASH diet is effective in attenuating high blood pressure. We also suggest that efforts to more widely implement adoption of the DASH diet would be beneficial to public health.

Kidney and cardiovascular risk in primary hypertension

In patients with primary hypertension, therapeutic strategies should be based on global cardiovascular risk profile rather than on the severity of blood pressure alone. Accurate assessment of concomitant risk factors and especially of the presence and extent of subclinical organ damage is of paramount importance in defining individual risk. Given the high prevalence of hypertension in the population at large, however, extensive diagnostic evaluation is often impractical or unfeasible in clinical practice. Low cost, easy to use markers of risk are needed to improve the clinical management of patients with hypertension. Early renal abnormalities such as a slight reduction in glomerular filtration rate and/or the presence of microalbuminuria are well known and powerful predictors of cardio-renal morbidity and mortality and provide a useful, low cost tools to optimize cardiovascular risk assessment. A greater use of these tests should therefore be implemented in clinical practice in order to optimize the management of hypertensive patients.

Estimated net endogenous acid production and risk of prevalent and incident hypertension in community-dwelling older people

AIM: To investigate the associations of dietary acid-base load with prevalent and incident hypertension in community-living Chinese older adults in Hong Kong.

METHODS: Participants aged ≥ 65 years participating in a cohort study examining the risk factors for osteoporosis completed a validated food frequency questionnaire (FFQ) at baseline between 2001 and 2003. Estimated net endogenous acid production (NEAP) was calculated using Frassetto’s method based on the diet’s protein to potassium ratio derived from the FFQ. Prevalent and 4-year incident hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or self-reported use of anti-hypertensive medications. Multivariable logistic regression was used for cross-sectional analysis (n = 3956) to assess the association between estimated NEAP and prevalent hypertension, and for longitudinal analysis (n = 795) on its association with 4-year incident hypertension, with adjustment for various potential socio-demographic and lifestyle factors.

RESULTS: Median estimated NEAP of the participants was 47.7 (interquartile range: 36.2, 60.9) g/mEq. Participants in the highest quartile of energy-adjusted estimated NEAP was associated with increased likelihood of prevalent hypertension than those in the lowest quartile of energy-adjusted estimated NEAP [multivariable OR = 1.66 (95%CI: 1.22 to 2.26, P_trend = 0.002)]. No significant association was observed between energy-adjusted estimated NEAP and risk of incident hypertension.

CONCLUSION: A high dietary acid load was independently associated with an increased likelihood of prevalent hypertension in ambulant older Chinese people in Hong Kong. The longitudinal analyses failed to show any causal relationship between dietary acid load and hypertension in this population.

Multi-slice computerized tomography critical role in transcatheter aortic valve implantation plan: Review of current literature

Transcatheter aortic valve implantation (TAVI) has been shown in improve outcome of severe aortic stenosis (AS) patients, deemed surgical high-risk or inoperable, and has grown popular in the past decade. The procedure requires accurate prior planning, and demands an integration of a “Heart Team” consisted from cardiac surgeons, interventional cardiologists, and imaging experts. The role of cardiac imaging and especially multi-slice computerized tomography (MSCT) has been a mainstay of pre-evaluation of severe AS patients that allows to accurately depict and size the cardiac and vascular structures, and has become the primary tool for procedural planning. This article is aimed to evaluate current uses of MSCT in severe AS patients undergoing TAVI, delineate the various measurements derived from this modality and review current literature regarding it’s advantages over other techniques.

Dairy: A lower percent investment in the volatile hypertensive environment

In cross-sectional and intervention studies, low-fat dairy has proven to be effective in lowering blood pressure in a hypertensive population. Contributing mechanisms include the angiotensin-converting enzyme-inhibiting effects of peptides and possible interplay between calcium and vitamin D. Easily added to the diet, low-fat dairy is an attractive addition to nutritional, lifestyle, and pharmacological interventions to treat hypertension.

Novel contributions of multimodality imaging in hypertension: A narrative review

Hypertension is currently one of the most prevalent illnesses worldwide, and is the second most common cause of heart failure, only behind ischemic cardiomyopathy. The development of novel multimodality imaging techniques in recent years has broadened the diagnostic methods, risk stratification and monitoring of treatment of cardiovascular diseases available for clinicians. Cardiovascular magnetic resonance (CMR) has a great capacity to evaluate cardiac dimensions and ventricular function, is extremely useful in ruling-out ischemic cardiomyopathy, the evaluation of the vascular system, in making the differential diagnosis for resistant hypertension and risk stratification for hypertensive cardiomyopathy and constitutes today, the method of choice to evaluate left ventricular systolic function. Computed tomography (CT) is the method of choice for the evaluation of vascular anatomy, including coronary arteries, and is also able to provide both functional and structural information. Finally, nuclear cardiology studies have been traditionally used to evaluate myocardial ischemia, along with offering the capacity to evaluate ventricular, endothelial and cardiac innervation function; information that is key in directing the treatment of the patient. In this narrative review, the most recent contributions of multimodality imaging to the patient with hypertension (CMR, CT and nuclear cardiology) will be reviewed.

Symplicity-3 hypertension trial: Basic and clinical insights

Symplicity-3 hypertension (HTN) was a recently completed clinical trial that was assumed to be the basis for the approved use of renal artery denervation for the treatment of resistant hypertension in the United States. Dramatic reductions in blood pressure had been reported in two clinical trials (Symplicity-1HTN, -2HTN) carried out in Europe, however Symplicity-3HTN did not show a significant reduction of systolic blood pressure in patients with resistant hypertension 6 mo after renal artery denervation as compared with a sham control. (Denervation group, blood pressure reduction: -14 ± 24, Sham control: -12 ± 26 mmHg). In this review we discuss several potential explanations for the failure of efficacy of Symplicity-3HTN taking into account basic and clinical factors which could have played a role in the discrepancy between the European and American experience.

From hypertension to heart failure

Hypertension is an increasing health problem worldwide especially among the elderly. Its therapeutical importance is indicated by the caused organ damages like hypertensive heart disease (HHD) and heart failure with the subsequent higher morbidity and mortality in the population. In HHD ventricular hypertrophy develops as a compensatory mechanism for pressure overload but as the left ventricular compliance decreases, the process can transform into heart failure with firstly preserved and then into reduced ejection fraction (HFpEF, HFrEF). The main characteristics of underlying mechanisms involve cardiomyocyte growth, vessel changes, increased collagen production in all of which several mechanical stress induced neurohumoral agents, signal transduction pathways are involved. According to the new ESC and AHA guidelines five main groups of antihypertensive agents can be applied for decreasing blood pressure and for the prevention of organ damages. Occasionally, patients are not able to tolerate antihypertensive medication because of side effects, drug intolerance or interactions thus it is more difficult to reach the target blood pressure values. Therefore there are several efforts to complete the existing therapeutical possibilities against the development of organ damages like inhibition of Rho/ROCK pathway (e.g., statins), regulation of ROS formation, influence on mitochondrial biogenesis and enhancing recombinant adenovirus hepatocyte growth factor gene. Hypertension induced oxidative stress causes DNA breaks producing the activation of nuclear poly(ADP-ribose) polymerase-1 (PARP) enzyme that leads to energy depletion and unfavorable modulation of different kinase cascades. PARP activation promotes the development of HHD, and its transition to heart failure. Therefore inhibition of PARP-enzyme offers another new therapeutical approach among hypertensive patients. The purpose of this review is to give a comprehensive summary about the most significant mechanisms in HHD and an insight into new potential therapies.

Clinical implication of hematological indices in the essential hypertension

Prognostic value of haematological indices, especially red cell distribution width, neutrophil lymphocyte ratio and mean platelet volume, was reported with numerous investigations in miscellaneous cardiovascular settings. Their major prognostic value was linked to oxidative stress and inflammation since their level was correlated with major inflammatory markers such as high sensitive C-reactive protein and interleukins. Oxidative stress and chronic inflammation are also postulated as the main pathophysiologic mechanism of essential hypertension (HT) and its vascular complication. Recently, correlation between HT and haematological parameters was searched in numerous studies, which has made the topic more popular. Herein, we reveal the correlation between haematological indices and HT and we also demonstrate the clinical implication of this correlation. Impaired haematological parameters may strongly indicate hypertensive end-organ damage.

Progress in neuregulin/ErbB signaling and chronic heart failure

Heart failure is one of the leading causes of death today. It is a complex clinical syndrome in which the heart has a reduced contraction ability and decreased viable myocytes. Novel approaches to the clinical management of heart failure have been achieved through an understanding of the molecular pathways necessary for normal heart development. Neuregulin-1 (NRG-1) has emerged as a potential therapeutic target based on the fact that mice null for NRG-1 or receptors mediating its activity, ErbB2 and ErbB4, are embryonic lethal and exhibit severe cardiac defects. Preclinical studies performed with animal models of heart failure demonstrate that treatment with NRG-1 significantly improves heart function and survival. Clinical data further support NRG-1 as a promising drug candidate for the treatment of cardiac dysfunction in patients. Recent studies have revealed the mechanism underlying the therapeutic effects of NRG-1/ErbB signaling in the treatment of heart failure. Through activation of upstream signaling molecules such as phosphoinositide 3-kinase, mitogen-activated protein kinase, and focal adhesion kinase, NRG-1/ErbB pathway activation results in increased cMLCK expression and enhanced intracellular calcium cycling. The former is a regulator of the contractile machinery, and the latter triggers cell contraction and relaxation. In addition, NRG-1/ErbB signaling also influences energy metabolism and induces epigenetic modification in cardiac myocytes in a way that more closely resembles healthy heart. These observations reveal potentially new treatment options for heart failure.

Diagnosis and management of thoracic aortic dissection: An update

Acute thoracic aortic dissection is part of the acute aortic syndrome triad. Caused by an intimal tear in the lumen of the aorta, it leads to the creation and propagation of a false lumen. In the acute setting this can lead to malignant hypertension, pain and end organ malperfusion. In the chronic setting it can lead to aneurysm formation and rupture. It remains the most common aortic emergency, affecting up to 4 per 100000 people per year in the United Kingdom and United States. Despite advances in treatment and centralisation of vascular services, it continues to be associated with a high pre-admission and in-hospital mortality. Dissection is classified in several ways according to anatomical extent, timing and underlying pathology, all of which guides clinical management. Traditionally, medical management has been the mainstay of treatment in patients with uncomplicated disease. Surgery has been used in symptomatic patients. With published information now available from several prospective international registries, we are beginning to see the advantages of newer surgical treatment options such as endovascular repair, in the acute setting. This review provides an update on diagnosis and management of aortic dissection, including new information that has become available in recent years.

Catheter ablation for atrial fibrillation in a subset of patients with concomitant hypertension

AIM: To study patients with atrial fibrillation and hypertension who had successful catheter ablation for changes in blood pressure 1 year later.

METHODS: A retrospective study was performed on patients who had catheter ablation for atrial fibrillation (AF) and hypertension (HTN) which included local autonomic ganglionated plexi denervation and pulmonary veins isolation. Of the records of 119 patients, follow-up data was found in order to determine the presence of sinus rhythm and data on systolic (SBP) and diastolic blood pressure at 2 wk, 3 mo, 6 mo and 1 year after the ablation procedure. Transthoracic echocardiograms were taken at the time of the catheter procedure to determine left atrial dimensions (LADs) and left ventricular size.

RESULTS: There was no significant difference in the pre-ablation mean blood pressures between the two groups (P = 0.08). After 1 year 33 of the 60 with AF and HTN were in sinus rhythm, of whom 12 had normal LADs, ≤ 4 cm Group 1, and 21 had enlarged left atria (LADs > 4 cm, Group 2). For Group 1, at 1 year of follow up, there was a significant difference in the SBP (119.2 ± 13 mmHg) compared to pre-ablation (142.6 ± 13.7 mmHg, P = 0.001). For Group 2, there was no significant difference in the SBP, pre-ablation (130.3 ± 17.5 mmHg) and at 1 year of follow up (130.4 ± 13.4 mmHg, P = 0.75). All patients were on similar anti-hypertensive medications. There was a trend for a greater left ventricular size in Group 2 compared to Group 1.

CONCLUSION: We suggest that Group 1 had HTN due to sympathetic hyperactivity, neurogenic HTN; whereas HTN in Group 2 was based on arterial vasoconstriction.

Hypertensive cardiomyopathy: A clinical approach and literature review

Hypertensive cardiomyopathy (HTN-CM) is a structural cardiac disorder generally accompanied by concentric left ventricular hypertrophy (LVH) associated with diastolic or systolic dysfunction in patients with persistent systemic hypertension. It occurs in the absence of other cardiac diseases capable of causing myocardial hypertrophy or cardiac dysfunction. Persistent systemic hypertension leads to structural and functional myocardial abnormalities resulting in myocardial ischemia, fibrosis, and hypertrophy. HTN-CM is predominantly a disease of impaired relaxation rather than impaired contractility, so patients are usually asymptomatic during resting conditions. However, their stiff left ventricles become incapable of handling increased blood volume and cannot produce appropriate cardiac output with the slight change of circulating volume that may occur during exercise. Importantly, the accompanying LVH is itself a risk factor for mortality and morbidity. Therefore, early detection of LVH development in patients with hypertension (referred to as HTN-CM) is critical for optimal treatment. In addition to pathological findings, echocardiography and cardiac magnetic resonance imaging are ideal tools for the diagnosis of HTN-CM. Timely diagnosis of this condition and utilization of appropriate treatment are required to improve morbidity and mortality in hypertensive patients. This review article presents an overview of the multidimensional impact of myocardial disorder in patients with hypertension. Relevant literature is highlighted and the effects of hypertension on cardiac hypertrophy and heart failure development are discussed, including possible therapeutic options.

Endocrine hypertension: An overview on the current etiopathogenesis and management options

Endocrine causes of secondary hypertension include primary aldosteronism, pheochromocytoma, cushing’s syndrome, hyperparathyroidism and hypo- and hyperthyroidism. They comprise 5%-10% of the causes of secondary hypertension. Primary hyperaldosteronism, the most common of the endocrine cause of hypertension often presents with resistant or difficult to control hypertension associated with either normo-or hypokalemia. Pheochromocytoma, a great mimicker of many conditions, is associated with high morbidity and mortality if left untreated. A complete history including pertinent family history, physical examination along with a high index of suspicion with focused biochemical and radiological evaluation is important to diagnose and effectively treat these conditions. The cost effective targeted genetic screening for current known mutations associated with pheochromocytoma are important for early diagnosis and management in family members. The current review focuses on the most recent evidence regarding causes, clinical features, methods of diagnosis, and management of these conditions. A multidisciplinary approach involving internists, endocrinologists and surgeons is recommended in optimal management of these conditions.

Antihypertensive effects of foods

Hypertension is one of the major risk factors for arteriosclerosis, which leads to cardiovascular disease and stroke. Several clinical trials revealed that control of the blood pressure is useful to reduce the morbidity and mortality associated with these diseases. However, the protective efficacy against these complications still remains at less than 50% even if the high blood pressure is treated by current medical drugs. Healthy diets are expected to not only prevent but also treat lifestyle-related diseases. Improvement of the dietary life, including low-salt diets, appropriate alcohol consumption, and calorie restriction, is important for the prevention of hypertension. In addition, green tea, which has been drunk on a daily basis in Japan and China since ancient times, possesses an antihypertensive effect, and it was revealed that its components with this effect are catechins. Many studies have been performed on the antihypertensive effects of foods. Therefore, functional foods and their ingredients, reported to possess antihypertensive effects in animal experiments and human clinical trials, are summarized in this review. Blood pressure might be controlled by improvement of the daily eating habits based on evidence regarding these functional foods, and a healthy longevity can be expected.

Diabetes, diabetic complications, and blood pressure targets

Association of diabetes with hypertension is frequent and it well known that high blood pressure potentiates the probability of diabetic patients to develop macrovascular and microvascular complications. Strong evidence obtained in a number of large scale prospective studies indicates that adequate blood pressure control in diabetic patients is highly beneficial for prevention of cardiovascular events. Nonetheless, only a limited proportion of hypertensive-diabetic individuals included in studies on anti-hypertensive treatment has met the predefined blood pressure goal. The optimal blood pressure goal to be pursued in diabetic patients with hypertension to guarantee effective protection from cardiovascular outcomes is still under intense debate and recommendations of current guidelines on hypertension treatment are still inconsistent. We comment here on the most important studies and conclude that current evidence does not conclusively support the need to reach a blood pressure target in hypertensive patients with diabetes different from nondiabetic hypertensive individuals.

Contribution of miRNAs to ion-channel remodelling in atrial fibrillation

Atrial fibrillation (AF) is the most commonly encountered clinical arrhythmia associated with pronounced mortality and morbidity, which are related to palpitations, fainting, congestive heart failure, and stroke. Prolonged episodes of AF promote AF persistence mainly due to electrical remodelling that alters ion-channel expression and/or function. MicroRNAs (miRNAs), a new class of non-coding mRNAs of around 22 nucleotides in length, have recently emerged as one of the key players in the gene-expression regulatory networks. The potential roles of miRNAs in controlling AF have recently been investigated. Several recent studies have provided promising results for a better understanding of the molecular mechanisms of AF. In this review, we summarize the mechanism of miRNAs as regulators of ion-channel gene expression and their role in causing AF through electrical remodelling.

Epidemiology of elevated blood pressure in youth and its utility for predicting adulthood outcomes: A review

Elevated blood pressure has been demonstrated to track from youth to adulthood and some have demonstrated an association between early-life blood pressure and subsequent atherosclerosis and cardiovascular disease. In addition, reports regarding the strength of tracking are inconsistent and the modifiable risk factors that affect the trajectory of blood pressure from youth to adulthood remain unclear. This paper comprehensively evaluated the existing classifications of youth hypertension and the current trends of youth hypertension. Further, evidence for the consequences of hypertension in youth has been comprehensively evaluated. Importantly, a review of the studies examining tracking from youth to adulthood has been performed and a number of studies investigating the factors affecting tracking has also been investigated. The overall consideration of this body of literature highlights the vital importance of identifying hypertension in youth to prevent complications in adulthood. Adiposity is regarded to be a factor affecting the progression of hypertension from youth to adulthood yet there is little evidence available for other modifiable factors. It is apparent that further research is necessary within this field in order to create effective preventative strategies to target youth hypertension.

Influence of periodontitis on abdominal aortic aneurysms

Periodontitis is known to be a risk factor for abdominal aortic aneurysm (AAA). However, the influence of periodontitis on AAA development is to be elucidated. This article is to review the relationship between periodontitis and AAA. We focused on the roles of specific periodontopathic bacteria in AAA, matrix metalloproteinases and toll-like receptors in the pathophysiology in the section of experimental analysis. Furthermore, we showed clinical data of periodontitis in patients with AAA. We concluded that periodontal pathogens play a critical role in the AAA development.

Hypertension in children with obesity

The prevalence of obesity related hypertension has dramatically increased in children with the parallel increase in pediatric obesity. This pediatric health problem may adversely affect cardiovascular health in adult life. The pathogenesis of hypertension in obese children is not widely understood. We therefore undertake this review to raise public awareness. Early childhood parameters like birth weight and postnatal weight gain may play important roles in risk for obesity and obesity related hypertension later in childhood and adult life. Further information is required to confirm this origin of hypertension so that appropriate measures are taken in the peri-natal period. The role of sympathetic nervous system has now been well established as one of the principle mechanisms involved in obesity related hypertension. The Renin-Angiotensin system, insulin resistance due to obesity and as a part of metabolic syndrome along with imbalance in adipokines such as leptin and adiponectin, cause activation of the sympathetic system, vasoconstriction, endothelial dysfunction and sodium reabsorption among other perturbations. Multi-step interventions targeting these various mechanisms are required to break the cycle of obesity and metabolic syndrome. Vitamin D deficiency, sleep apnea due to airway obstruction and hyperuricemia may also play a significant role and should not be ignored in its early stages. Obesity is a risk factor for other co-morbid conditions like chronic kidney disease and fatty liver which further accentuate the risk of hypertension. Increased awareness is required to prevent, diagnose and treat obesity related hypertension among the pediatric population.

ARB affects nicotine-induced gene expression profile in human coronary artery endothelial cells

AIM: To investigate the effects of nicotine and nicotine plus angiotensin II receptor blocker (ARB) on the gene expression profile of human coronary artery endothelial cells (HCAECs).

METHODS: The changes in gene expression profiles in HCAECs treated with nicotine and nicotine plus ARB olmesartan were analyzed by DNA microarray. In nicotine-treated HCAECs, 432 genes selected by P < 0.01 were greater than 1.5-fold compared with the untreated cells. Data were analyzed using IPA (Ingenuity^® Systems, www.ingenuity.com).

RESULTS: The gene expression levels of tumor necrosis factor-α, collagen type 1, matrix metalloproteinase-10, and disintegrin and metalloprotease domain 8, which are related to “cardiovascular function and disease”, were significantly increased. In canonical pathway analyses using IPA, “atherosclerosis signaling” was strongly affected by nicotine treatment and this effect was reduced by co-incubation with ARB olmesartan. These data indicate that the deleterious cardiovascular consequences of cigarette smoking may, at least in part, be due to the nicotine-induced gene expression profile related to “atherosclerosis signaling”.

CONCLUSION: The inhibitory effect of ARB against the nicotine-induced gene expression profile may possibly induce anti-atherosclerotic effects that are independent of those from lowering the blood pressure.

Brain inflammation in neurogenic hypertension

One likely mechanism of essential hypertension (EH) is increased sympathoexcitation due to abnormal functions in the cardiovascular center of the brain. Recent findings obtained using experimental animal models of EH have shown that abnormal inflammation in the cardiovascular center may contribute to the onset of hypertension. Inflammatory molecules such as cytokines and reactive oxygen species released from the inflamed vasculature and glial cells in the medulla oblongata and hypothalamus might directly or indirectly affect neuronal functions. This in turn could increase sympathetic nerve activity and consequently arterial pressure. Abnormal inflammatory responses in the brain could also be central mechanisms underlying angiotensin II-related EH. In this review, we present the current understanding of EH mechanisms with regard to inflammatory responses in the cardiovascular center.

A hypothesis on the relationship between tea drinking and sexual activity

As a major beverage in the world, the health benefits of drinking tea have been reported in numerous studies. The effects of green tea are mainly attributed to its polyphenol content, although caffeine, accounting for 2%-4%, appears to be related to the adaptation of mental energy by increasing alertness, attention and cognitive function, as well as elevating mood. L-Theanine, a unique amino acid in tea, has neuroprotective and mood effects. In addition, some studies on functional neuroanatomy and cerebral control of sexual function have demonstrated that the thalamus and hypothalamus play a role in emotional changes, memory and sexual behavior patterns. Our recent epidemiology research has unexpectedly found that tea drinking was positively related with sexual orgasm and sexual satisfaction in female hypertensive patients. We therefore hypothesize that long-term regular consumption of tea may play a role in sexual activity.

Blood pressure variability and cerebrovascular disease

Variability is an aspect of blood pressure (BP) relatively unknown and poorly evaluated systematically in clinical practice. Although the introduction of intensive BP measurement methods, such as ambulatory blood pressure monitoring provided evidence of the importance of BP variability in the short-term, more recently, however, emphasis has been placed on the relevance of variability of BP in the medium- and long-term. The adverse cardiovascular consequences of high BP not only depend on absolute BP values, but also on BP variability. Independently of mean BP levels, BP variations in the short- and long-term are associated an increased risk of cardiovascular events and mortality. Also, it has been suggested that modulation of such variability may explain the different level protection exerted by different antihypertensive-drug classes.

Adipose tissue dysfunction and the pathogenesis of metabolic syndrome

Metabolic syndrome is a growing research area. The underlying mechanisms of metabolic syndrome are still not very clear. Insulin resistance, obesity, inflammation and oxidative stress may play an important role in the pathogenesis of metabolic syndrome. The role of adipose tissue dysfunction is emphasized during the development of obesity. Adipose tissue is identified as a complex endocrine organ and its metabolic functions extend well beyond the classical actions of thermoregulation and of storage and release of fatty acids. Chronic low-grade inflammation activated by the immune system in adipose tissue is a key contributing factor to type 2 diabetes mellitus and cardiovascular diseases. Visceral obesity results in cell autonomous impairment in insulin signaling that leads to insulin resistance. Chronic inflammation in adipose tissue has gained acceptance as a lead promoter of insulin resistance in obesity. Furthermore, obesity creates oxidative stress conditions in adipose tissue that not only correlates with insulin resistance but is also causative in its development. Oxidative stress may be a mechanistic link between several components of metabolic syndrome and cardiovascular diseases, through its role in inflammation and its ability to disrupt insulin-signaling. The study around adipose tissue dysfunction will help to understand the pathogenesis of metabolic syndrome and may bring effective therapy in treatment of metabolic syndrome related diseases. Therefore, this review mainly focuses on the roles of adipose tissue dysfunction in inflammation, insulin resistance, and oxidative stress in the pathogenesis of metabolic syndrome.

Induction of tissue angiotensin II-forming activity in two-kidney, one-clip hypertensive hamster model

AIM: To evaluate the role of chymase in blood pressure regulation and its actions on tissue renin-angiotensin system.

METHODS: A two-kidney, one-clip (2K1C) hypertension model was developed in Syrian hamsters, which have a human-type chymase. Either an angiotensin (Ang) converting enzyme (ACE) inhibitor (ACE-I; temocapril, 30 mg/kg per day), Ang II type 1 receptor antagonist (ARB; CS866, 10 mg/kg per day), or vehicle was administered, beginning 2 wk after renal artery clipping and continued for 16 wk. At the end of this protocol, hearts, aortas, and lungs were removed, and total Ang II-forming activities and ACE- and chymase-dependent Ang II-forming activities were determined.

RESULTS: After renal artery clipping, systolic blood pressure in the vehicle group was significantly higher compared with that in a sham-operated group throughout the experimental period. Both ACE-I and ARB treatments revealed similar antihypertensive effects. Moreover, in the vehicle group, cardiac total and chymase-dependent Ang II-forming activities significantly increased at 18 wk after clipping. Further, cardiac total and chymase-dependent Ang II-forming activities decreased significantly after ACE-I or ARB treatment for 16 wk. In addition, chymase-dependent Ang II-forming activity significantly increased in the aorta, although these changes were inhibited only by ARB. ARB treatment was more effective compared with ACE-I treatment in reversing the changes in tissue Ang II formation, particularly in the aorta, despite their similar antihypertensive effects.

CONCLUSION: Chymase does not play a major role in maintaining blood pressure and tissue ACE and chymase are regulated in a tissue-dependent manner in 2K1C hamster.

Seasonal changes in blood pressure: Cardiac and cerebrovascular morbidity and mortality

Cold is a seasonal and circadian risk factor for cardio- and cerebrovascular morbidity and mortality. Colder temperatures have been associated with higher blood pressure (BP), based on studies which show that BP levels measured during the summer months are generally lower than those measured during the winter months. Residents in geographic areas which have greater seasonal temperature differences show greater fluctuation in BP. Surprisingly, atmospheric pressure, rainfall, and humidity were not related to BP levels. The increased sympathetic nervous activity due to cold, as evidenced by elevated BP and by plasma and urinary catecholamines, has been proposed as being the underlying etiology. Patients with heart failure may experience, in cold conditions, endothelial dysfunction and produce fewer endogenous vasodilators (e.g., nitric oxide, prostaglandins) and more endogenous vasoconstrictors (e.g., endothelin), thus increasing afterload. Arterial stiffness is also related to seasonal BP changes. Increased BP, arterial stiffness and endothelial dysfunction could predispose to increased coronary and cerebrovascular events. Improved protection against lower temperatures or increased doses of existing medications or the addition of newer medications could lead to a reduction in increased cardiovascular mortality in winter. Here, we briefly review findings from existing literature and provide an update on seasonal long-term variation in BP along with the related complications.

Nice new hypertension guidelines

The National Institute for Clinical Excellence in the United Kingdom published a new set of guidelines on the management of primary hypertension in August 2011, reflecting some important changes in the diagnosis and treatment of hypertension. Ambulatory blood pressure measurement is now the new gold standard for diagnosis. Home blood pressure monitoring is a useful alternative for the diagnosis and monitoring of hypertension. Calcium channel blockers (CCB) and blockers of the renin-angiotensin system have surpassed diuretics and β-blockers as first line options. Patients younger than 55 should receive an angiotensin-converting enzyme inhibitor, or an angiotensin receptor blocker if the former is not tolerated. Older patients should be started on a CCB. A thiazide diuretic can be added to these two groups for better blood pressure control, but. chorthalidone and indapamide are the preferred diuretics as they showed favorable outcomes in large clinical trials. Treatment with these three drug classes should be sufficient in the majority of patients, but if triple therapy is still insufficient, referral to a hypertension specialist is recommended. Additional diuretic therapy, spironolactone, or an α or β blocker can be used as the fourth line treatment.

Oxidative stress-mediated effects of angiotensin II in the cardiovascular system

Angiotensin II (Ang II), an endogenous peptide hormone, plays critical roles in the pathophysiological modulation of cardiovascular functions. Ang II is the principle effector of the renin-angiotensin system for maintaining homeostasis in the cardiovascular system, as well as a potent stimulator of NAD(P)H oxidase, which is the major source and primary trigger for reactive oxygen species (ROS) generation in various tissues. Recent accumulating evidence has demonstrated the importance of oxidative stress in Ang II-induced heart diseases. Here, we review the recent progress in the study on oxidative stress-mediated effects of Ang II in the cardiovascular system. In particular, the involvement of Ang II-induced ROS generation in arrhythmias, cell death/heart failure, ischemia/reperfusion injury, cardiac hypertrophy and hypertension are discussed. Ca²⁺/calmodulin-dependent protein kinase II is an important molecule linking Ang II, ROS and cardiovascular pathological conditions.

Contribution of lysosomal cysteine proteases in cardiac and renal diseases

Cardiac and renal diseases (CRDs) are characterized by extensive remodeling of the extracellular matrix (ECM) architecture of the cardiorenal system. Among the many extracellular proteolytic enzymes present in cardiorenal cells and involved in ECM remodeling, members of the matrix metalloproteinase family and serine protease family have received the most attention. However, recent findings from laboratory and clinical studies have indicated that cysteine protease cathepsins also participate in pathogenesis of the heart and kidney. Deficiency and pharmacological inhibition of cathepsins have allowed their in vivo evaluation in the setting of pathological conditions. Furthermore, recent studies evaluating the feasibility of cathepsins as a diagnostic tool have suggested that the serum levels of cathepsins L, S and K and their endogenous inhibitor cystatin C have predictive value as biomarkers in patients with coronary artery disease and heart and renal failure. The goal of this review is to highlight recent discoveries regarding the contributions of cathepsins in CRDs, particularly hypertensive heart failure and proteinuric kidney disease.

Evidence, hypotheses and significance of MAP kinase TNNI3K interacting with its partners

TNNI3K is a cardiac-specific and cardiac troponin I (cTnI)-interacting MAP kinase, known to play important roles in promoting cardiac differentiation, maintenance of beating rhythm and contractual force. The molecular structure of TNNI3K contains three kinds of domain: a seven or ten NH₂-terminal ankyrin repeat domain followed by a protein kinase domain and a COOH-terminal serine-rich domain. There are many binding sites in the structure of TNNI3K for binding to ATP, magnesium, nucleotide, protein kinase C, antioxidant protein 1 (AOP-1) and cTnI, indicating TNNI3K has many interacting partners. This review summarizes the evidence, hypothesis and significance of TNNI3K interacting with TNNI3 and its other putative interaction partners. From the literature, the interaction partners of TNNI3K are divided into 2 types following their phenotypic pattern of functions, positive interaction (to increase the cardiac performance) or negative interaction (to suppress the cardiac performance). Following their binding sites, it also can be divided into other 2 types: binding to C-terminal domain (e.g., cTnI) or binding to both ankyrin repeat domain and C-terminal domains (AOP-1). To date, a well understood partner of TNNI3K is cTnI, from the molecular structure, physiological function, mechanisms and its significance in some physiological and pathophysiological conditions. There are many reasons to believe that, with more understanding on the TNNI3K interacting with its partners, we can understand more roles of TNNI3K in some cardiac diseases.

A survey of recent reports on ambulatory blood pressure monitoring

This article is a review of 25 publications on ambulatory blood pressure monitoring (ABPM) and the importance of its results in everyday clinical practice. These studies, published in 2008-2011, were selected from the Scopus database, but are also available in Pubmed. They were prepared by researchers from around the world, concerned with the problems of proper control of blood pressure (BP), and of abnormalities in the circadian pattern of BP in patients with arterial hypertension, diabetes mellitus or renal failure. In the first part of this article, I analyse publications focused on some nuances in the methodology of ABPM and recommend ways to avoid some traps, related not only to the individual patient but also to the device used and the technical staff. The next section is devoted to the advantages of ABPM as a diagnostic tool which enables clinicians to learn about patients’ BP during sleep, and emphasizes the practical implications of this information for so-called chronotherapy. This section also presents some new studies on the prognostic value of ABPM in patients with cardiovascular (CV) risk. Some recent articles on the results of various methods of pharmacological treatment of arterial hypertension in different age groups are then described. The observations presented in this article may be helpful not only for researchers interested in the chronobiology of the CV system, but also for general practitioners using ABPM.